D626 Task 1 Policy Analysis and Advocacy Brief Example

Going to Work Sick Because Staying Home Costs a Day's Pay: A Policy Analysis of Paid Sick Leave, a Comparison of U.S. and International Systems and an Advocacy Brief for a Composite State Bill

Student Name

Leavitt School of Health, Western Governors University

D626: Public Health Policy and Advocacy, Task 1

Course Instructor

Month Day, Year

Going to Work Sick Because Staying Home Costs a Day's Pay: A Policy Analysis of Paid Sick Leave, a Comparison of U.S. and International Systems and an Advocacy Brief for a Composite State Bill

Why a Labor Law Is a Health Law

A line cook with a stomach bug, a home health aide with influenza and a cashier whose child has a fever all face the same choice when their job offers no paid sick leave: go to work, or lose the day's wages and perhaps the job. The choice matters to everyone around them. Using the 2013 National Health Interview Survey, DeRigne et al. (2016) found that working adults without paid sick leave were more likely than those with it to go to work while ill, were 3.0 times more likely to forgo medical care for themselves and 1.6 times more likely to forgo care for family members; the lowest-income workers without leave were at the highest risk of delaying or forgoing care. Paid sick leave therefore affects two public health goals at once: limiting the spread of infectious disease in workplaces, schools and restaurants, and allowing people to get preventive and acute care when they need it.

The state in this paper, a composite called Ridgeland, has no paid sick leave law and a state law that prevents cities from passing their own. A bill in the coming session would require employers to let workers earn one hour of paid sick time for every 30 hours worked, up to 40 hours a year, usable for their own illness, a family member's care or preventive visits.

Comparing Systems

The United States has no national permanent paid sick leave requirement. The Family and Medical Leave Act of 1993 provides unpaid, job-protected leave, but its minimum hours, job tenure and employer size rules exclude many workers, and Heymann et al. (2021) found that those rules exclude women, Black, Indigenous, multiracial and Latinx workers disproportionately. What coverage exists comes from a patchwork of state and city laws, federal contractor rules and employer choice, so a worker's access depends on where they live and who employs them.

Most other countries treat paid sick leave as a basic labor standard. In a study of legislation in the 193 UN member states, Heymann et al. (2021) found that 94% of countries provide permanent paid sick leave; none of those broadly restrict it by employer size, and 93% cover part-time workers without a minimum hours requirement. Designs differ: some countries require employers to pay directly, others pay benefits through social insurance funded by payroll contributions, and many combine the two, with the employer paying for the first days and insurance paying after. Gaps remain even abroad. An earlier analysis of the same 193 countries found that 27% do not pay from the first day of illness, which discourages workers from staying home early in an infection, and 58% lack explicit provisions covering self-employed and gig workers (Heymann et al., 2020).

Evaluating the Evidence From U.S. Laws

Two natural experiments give the strongest evidence that paid sick leave affects disease spread. Pichler and Ziebarth (2017) studied U.S. city and state sick pay mandates and found that rates of influenza-like illness fell when employees gained access to paid sick leave, which they attributed to fewer contagious workers attending work. During the pandemic, the Families First Coronavirus Response Act temporarily gave many workers up to two weeks of emergency paid sick leave. Using a difference-in-differences design that compared states where workers newly gained leave with states where most already had it, and adjusting for testing and stay-at-home orders, Pichler et al. (2020) estimated about 400 fewer confirmed COVID-19 cases per state per day, roughly one prevented case per day for every 1,300 workers who newly gained leave.

The evidence has limits. The studies estimate average effects and cannot show exactly which workplaces changed, and most U.S. laws cover only part of the workforce, so the full effect of a universal policy is not directly observed. The consistency of findings across influenza and COVID-19, and the strength of the designs, nevertheless make a causal link between paid sick leave and less disease spread well supported.

Ethical Analysis

Several ethical principles apply. The harm principle supports the policy: workers who come in sick expose coworkers and customers who did not consent to that risk, and the people most exposed, such as restaurant patrons and residents of care homes, cannot protect themselves. Justice supports it strongly: the workers least likely to have paid leave are low-wage, part-time and service workers, who are also most likely to work with the public and least able to absorb a lost day's pay. A policy that leaves access to employer choice therefore concentrates both the financial and the health burden on those with the least.

The competing consideration is the burden on employers, especially small businesses with thin margins, and the principle that a public health measure should impose the least burden necessary to meet its goal. That principle argues for designing the policy to limit costs, through accrual rather than a lump sum, an annual cap and reasonable documentation rules, rather than for leaving workers without coverage. It also argues against exempting small employers entirely, since the international evidence shows that broad coverage is workable and exemptions would leave many of the lowest-paid workers unprotected.

Advocacy Brief: Paid Sick Time for Ridgeland Workers

The problem. Hundreds of thousands of Ridgeland workers, most of them in food service, retail, child care and home care, lose pay when they are sick. Many work anyway, spreading illness to customers, patients and children, and many delay care until problems are more serious and more costly.

The proposal. Workers would earn one hour of paid sick time for every 30 hours worked, up to 40 hours a year, for their own health needs, a family member's care or preventive visits. Documentation would not be required for absences of three days or fewer.

The evidence. When U.S. workers gained paid sick leave, influenza-like illness fell (Pichler & Ziebarth, 2017), and during the pandemic, emergency paid sick leave prevented an estimated 400 confirmed COVID-19 cases per state per day (Pichler et al., 2020). Workers without leave are three times more likely to skip their own medical care (DeRigne et al., 2016).

Answering business concerns. Cost: accrual caps the maximum at five days a year, and use is usually lower. Abuse: accrual means leave is earned, not granted up front, and employers may require documentation for longer absences. Small employers: 94% of countries provide paid sick leave without broad exemptions for employer size (Heymann et al., 2021), and businesses gain from fewer outbreaks among staff and less turnover. Competition: a statewide standard applies to every employer equally, so no business is undercut by a competitor that makes employees work sick.

The request. Legislators should pass the bill as written, without a small-employer exemption, and fund outreach so that workers and employers know the rules.

Conclusion

Paid sick leave is a labor policy with measurable public health effects: it lets contagious workers stay home and lets people get care before problems grow. The United States stands apart from most countries in lacking a national standard, and the evidence from U.S. laws that do exist shows reduced disease spread. Ethical analysis supports broad coverage because the workers now excluded bear the greatest burden. The advocacy brief turns that analysis into a specific request that answers the objections legislators are most likely to hear.

References

DeRigne, L., Stoddard-Dare, P., & Quinn, L. (2016). Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. Health Affairs, 35(3), 520-527. https://doi.org/10.1377/hlthaff.2015.0965

Heymann, J., Raub, A., Waisath, W., McCormack, M., Weistroffer, R., Moreno, G., Wong, E., & Earle, A. (2020). Protecting health during COVID-19 and beyond: A global examination of paid sick leave design in 193 countries. Global Public Health, 15(7), 925-934. https://doi.org/10.1080/17441692.2020.1764076

Heymann, J., Sprague, A., Earle, A., McCormack, M., Waisath, W., & Raub, A. (2021). US sick leave in global context: US eligibility rules widen inequalities despite readily available solutions. Health Affairs, 40(9), 1501-1509. https://doi.org/10.1377/hlthaff.2021.00731

Pichler, S., Wen, K., & Ziebarth, N. R. (2020). COVID-19 emergency sick leave has helped flatten the curve in the United States. Health Affairs, 39(12), 2197-2204. https://doi.org/10.1377/hlthaff.2020.00863

Pichler, S., & Ziebarth, N. R. (2017). The pros and cons of sick pay schemes: Testing for contagious presenteeism and noncontagious absenteeism behavior. Journal of Public Economics, 156, 14-33. https://doi.org/10.1016/j.jpubeco.2017.07.003